Provider Demographics
NPI:1003423120
Name:MAGNOLIA ONE RESOURCES INC.
Entity Type:Organization
Organization Name:MAGNOLIA ONE RESOURCES INC.
Other - Org Name:MAGNOLIA PROVIDER SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CANTINA
Authorized Official - Last Name:AUSBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-342-6679
Mailing Address - Street 1:16303 LEEDSWELL LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-6460
Mailing Address - Country:US
Mailing Address - Phone:832-342-6679
Mailing Address - Fax:
Practice Address - Street 1:16303 LEEDSWELL LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-6460
Practice Address - Country:US
Practice Address - Phone:832-668-0787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAGNOLIA ONE RESOURCES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-24
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services